Major Incident Plan

Reference Number :

NHSCT/09/199

Responsible Directorate :

Acute Hospital Services

Replaces (if appropriate):

Legacy Causeway Trust Hospital and United Hospital - Major Incident Plan

Policy Author/Team : Type of document :

Elaine Coulter Corporate Plan General Manager – Acute Operational Support/ Eugene Hagan Emergency Planning Co-Ordinator

Approved by : Date Policy disseminated by Equality Unit : Governance Management Board 28 September 2009 Date Approved :

1 September 2009

NHSCT MISSION STATEMENT To provide for all the quality of services we would expect for our families and ourselves

Major Incident Plan

Approved Sept 2009

This is a controlled document and must not be photocopied without permission of the Director with Portfolio for Emergency and Business Continuity Planning

1 Contents Page No

Introduction to Emergency Planning & Roles/Responsibilities of Organisations 4 – 8

Objectives of The Major Incident Plan 9

Activation of The Major Incident Plan 10

Alert Procedure/Response (Hospital/Community) 11-13

Control and Information Team (CIT) - Hospital Major Incident 14

Location of Control & Information Teams 15

Major Incident in the Community 16

Northern Health and Social Care Trust (Silver Command) 17

Briefing/Debriefing/Care of Staff 18 - 19

General Roles/Responsibilities 20 - 36

Section 1 Chief Incident Control Officer 20

Section 2 NIAS 22

Section 3 Telephonist 23 - 24

Section 4 Emergency Department Sister 25

Section 5 Emergency Department Consultant 26

Section 6 Nursing Incident Officer 27

Section 7 Patient Flow Co-ordinator 28

Section 8 Services/Information Manager 29 - 30

Section 9 Radiography Department 31

Section 10 Portering Services 32

Section 11 Corporate Communications 33

Section 12 Hospital Social Work Service 34

Section 13 Pathology 35

Section 14 Stand down 36

APPENDICES

Page No

1 Control and Information Team (CIT) Membership 37 - 39

2 Telephonist 40 - 42

3 INTRODUCTION

The Northern Health and Social Care Trust became operational on 1 April 2007. It provides services to the areas formerly covered by Homefirst, Causeway and United Hospitals Trusts.

The Trust is geographically the largest in Northern Ireland and employs approximately 14,000 staff providing services to a population of around 440,000 both rural and suburban communities.

The Trust provides a comprehensive range of hospital and community based health and personal social services. It is coterminous with 10 local council areas (Ballymoney, Coleraine, Moyle, Antrim, Ballymena, Magherafelt, Cookstown, Larne, Carrickfergus and Newtownabbey), and 4 PSNI Districts (H, D, G & F).

4 Introduction to Emergency Planning

Within the Northern Ireland Civil Contingencies Framework, (NICCF) November 2005, based upon the Civil Contingencies Act 2004 introduced to the UK, is a set of guiding principles and “is primarily about what organisations should do rather than how they should do it”. The then Secretary of State for NI, Peter Hain MP, stated that he “expects NI to attain the same standards of protection, preparedness and response as exists elsewhere in the UK”. The framework sets standards, and for certain organisations, Police Service of Northern Ireland and Maritime Coastguard Agency, it has a statutory basis. However, it is implicit in the document that Health and Social Services Trusts are expected to maintain a level of civil contingencies preparedness as is commensurate with its roles and responsibilities, as it applies to emergency planning response.

By ‘civil contingencies’ we mean… “Events and situations impacting on the community which may or may not occur, but would lead to an emergency if it did…. and covers all the hazards and threats that could impact upon human welfare, the environment …. And are the activities undertaken by individuals and organisations to prevent emergencies and critical business interruptions to mitigate and control their effects and to prepare and respond …” (NI Civil Contingencies Framework Chapter 2).

The document introduces core principles which place a number of responsibilities on organisations, to ensure that civil contingency activities become part of normal business planning activities, including risk assessment, development and maintenance of plans, organisational preparedness and response to a declared emergency. It also details guiding principles, established by the UK Group, on how we should implement these duties.

The document ‘A Guide to Emergency Planning Arrangements in N Ireland (July 2004 CEPU/OFMDFM) sets out …”a framework to assist organisations to manage and co-ordinate their civil protection activities”. Section 5.23 clarifies the responsibilities of Health and Social Services Trusts -:

Co-ordination of health services Provision of appropriate immediate, medium and Long-term in-patient and community care for those affected by emergencies Welfare services including provision of Rest Centre Accommodation Provision of resources for planning, training and response and In conjunction with the N Ireland Ambulance Service …provision of emergency response from mobile medical teams and E&D departments of hospitals (Section 5.8) and in (Section 5.2) With the Police Service of Northern Ireland it commits the Trust to assisting the police in evacuation procedures.

5 There is also a need for the Trust to liaise with other organisations or agencies to ensure a multi-agency response. We are reminded that …”no single organisational arrangement will be appropriate to each and every type of major incident” [(1.7) Dealing with Disaster Revised 3 rd edition (Cabinet Office)]. And that …”inter organisational management and co-ordination to ensure organisations work together in a controlled and coherent way in order to meet the immediate, medium and long-term needs”… is needed (Guide to Emergency Planning Arrangements in Northern Ireland July 2004). “Organisations should work both individually and in collaboration with each other on certain key issues” (Dealing with Disaster; Revised 3 rd edition (2.1). This concept of working together is known as Integrated Emergency Management (IEM). Hence the Trust in addressing issues under the broad heading of emergency planning should look for …”mutual aid arrangements with parallel organisations …within the planning process” (2.7, Dealing with Disaster Revised 3 rd edition Cabinet Office).

Integrated Emergency Management

Emergency Services and Health and Social Care Trusts involved in the response to a major emergency need to co-operate effectively, hence close collaboration at the planning, exercise and response stage are essential. Also important is understanding of the role and remit of such partner agencies to ensure a truly integrated emergency management approach. In the majority of situations the Trust will not have personnel at the scene of the incident, the organisations present there will be Police Service of Northern Ireland (PSNI), Northern Ireland Fire & Rescue (NIFR), and Northern Ireland Ambulance Service (NIAS).

Main Responsibilities of these agencies are:

Police Service of Northern Ireland (PSNI)

• Security of the scene • Documentation procedure if required • Identification and reuniting of family members • Criminal investigation • Body recovery • Act as a representative of the Coroner’s office

Northern Ireland Fire & Rescue Service (NIFRS)

• Put out a fire • Search and rescue • Decontamination of the area and affected individuals • Establish safe working area

Northern Ireland Ambulance Service (NIAS)

• Provision of First Aid, Nursing & Medical Services • Patient assessment & Observation • Provision of Ambulance Transport

During a major incident it is the responsibility of the NIAS to decide which hospital will be designated to receive patients. Not all hospitals will receive seriously injured patients, some may receive less seriously injured patients or following negotiations admit patients decanted from a receiving hospital.

Acute Hospitals

Provision of Hospital Emergency Services to injured persons and any subsequent medical treatment required.

An alert procedure initiated by NIAS will be triggered should a ‘Trust Acute Hospital’ be designated as a receiving hospital. Should such an event occur, the hospital will decide if it needs to initiate its Major Incident Plan or if it can manage to deal with the matter as “per normal business.” If the latter is the case the hospital may decide to initiate its own Business Continuity Management (BCM) plan to cope with the influx of patients.

Community

Management/staffing of Emergency Support Centres

Designated Trust staff known as the Emergency Response Team are the first responders to a major incident happening in the community where an Emergency Support Centre has been established.

Responsibility within such a Centre includes

• Management of Emergency Support Centre including registration & provision of meals • General Welfare of persons • Provision of psychological support and advice at Emergency Support Centre • Post event, provide a short term follow up service, if appropriate, to survivors and their families and to family members of deceased persons. • Management of Relatives & Friends Centre (if opened)

See Section Major Incident in the Community Page 16.

A separate multi-agency protocol “Emergency Support Centre Provision“ sets out explicitly the roles/responsibilities of the various agencies in attendance at an Emergency Support Centre”. Agencies include NHSCT, PSNI, NIAS, Local Councils/owners of buildings (or a Representative organisation, British Red Cross/St John’s/Knight of Malta).

Local Councils

The Council will have a lead role when the emergency moves from response phase to the recovery phase. Separate protocols and procedures between various agencies and each local Council address these matters.

• In a situation where there are a number of uninjured persons or where persons have very minor injuries, not requiring hospital treatment, an Emergency Support Centre will be set up in the community. It is the council’s responsibility to provide a suitable building for use as an Emergency Support Centre • Maintenance of Council building (heating/lighting etc) whilst used as an ESC • Recovering strategy including clearing debris, prevention of contamination of waterways etc in conjunction with appropriate agencies e.g. Dept of Agriculture & Rural Development.

Objectives of the Major Incident Plan are to : ----

• Develop a robust plan to ensure a cohesive and comprehensive organisational response in the event of a major incident being declared

• Provide appropriate arrangements to ensure a safe and secure environment for the assessment and treatment of casualties brought to the hospital

• Ensure sufficient trained and appropriate staff are rapidly mobilised to deal with a major incident

• Provide an adequate level of clinical response including provision of specialist health care to casualties in the hospital

• Establish clear decision making process including Command & Control

• Establish and maintain good communications channels both internal to the organisation and with appropriate external agencies/departments e.g. with NIAS, PSNI, other hospitals responding to the emergency, DHSSPS and Regional Health & Social Care Board

• Maintain communications with Family & Friends of patients/survivors, Police Casualty Bureau

• Maintain communication with the media.

• Provide a safe and secure environment for staff including health and safety, and welfare considerations of staff responding to an emergency

• Manage and provide adequate staffing levels at Emergency Support Centre(s), and Family & Friends Centre(s) established in the community

• Provide appropriate resources and availability of same.

• Ensure sustainable response throughout the duration of the major incident

Activation of the Major Incident Plan

Responsibility for the activation of the plan shall rest as follows : -

• Hospital Site with the ED Consultant / Senior ED doctor on duty, who has responsibility for the hospital.

• Community Incident - with the Emergency Response Manager or his deputy or a member of the Trust’s Emergency Response Team (ERT).

In such events, (Hospital/Community) the Director with responsibility for Emergency Planning must be notified immediately who in turn will notify the Chief Executive and other Senior Management Team members as appropriate.

For clarification, the activation of the Major Incident Plan will be as a result of “An event or situation which threatens serious damage to human welfare in a place in the UK, the environment of a place in the UK or war, or terrorism, which threatens serious damage to the security of the UK.”

Damage would be “serious” if:

The emergency would be likely seriously to obstruct an organisation in the performance of its functions; or

If it is likely that the organisation:

Would consider it necessary or desirable to act to prevent reduce, control or mitigate the emergency’s effects, or otherwise take action, and

Would be unable to act without changing the deployment of its resources or acquiring additional resources.

(Source: The NI Civil Contingencies Framework)

Under present arrangements it is likely that the first indication of an incident will be relayed to the Trust by either NIAS/PSNI/NIFRS.

The alert may also come from other sources (local Council) or a sudden influx of persons needing emergency medical care, which disrupts or threatens to disrupt normal service delivery.

Alert Procedure

Under present arrangements, it is most likely that the first indication will be relayed to the Hospital by either the NIAS or PSNI.

In the event of an influx of patients to the Emergency Department (ED), who arrive by means of their own transport, ED Consultant or Senior ED Doctor on duty will initiate an alert.

There may be situations which do not require a hospital response, e.g. flooding or evacuation. In these instances, the first indication may be a phone call from PSNI or local Council to Trust Headquarters, Emergency Planning Office or outside normal business hours to the Out of Hours Emergency Social Work Service. A major incident for another service e.g. NIAS may not be a hospital major incident, and vice versa.

Standard Alert Messages (used by NIAS/PSNI/NIFRS)

(1) Major Incident - Potential (this alerts the Trust that a major incident response may be needed)

(2) Major Incident – cancelled (3) Major Incident declared Activate Plan (this informs the Trust that no (alerts the Trust of the need to major incident response activate their Major Incident is needed) Plan and mobilise appropriate staff and resources)

(4) Major Incident - stand down (Hospital/Community have responded to and dealt with the major incident and can now return to normal service)

Response

Hospital • A call to the hospital switchboard conveying message (1), (2) or (3) will be put through immediately to ED Consultant. The telephonist will also contact the appropriate staff depending on the message.

• For an event originating from an influx of patients to ED, ED Consultant will immediately inform hospital

11 switchboard and advise message (1), (2) or (3).

• Should a call go directly to ED, ED Consultant will immediately inform hospital switchboard of message received (1), (2) or (3).

It is the responsibility of ED Senior Doctor or Nurse in Charge to clarify with the caller details of the event and decide upon the action needed, i.e.

• can manage to deal with the incident “as per normal business” or • need to initiate the Major Incident Plan

It is the responsibility of the Telephonist to immediately inform key individuals of the decisions made, ie (1), (2) or (3) see Page 41.

When a Major Incident Declared/Activate Plan decision is made. The person activating the plan ( ED Consultant)must

• inform the hospital switchboard and request the telephonist to carry out the agreed Major Incident call out procedure • Commence a log (written record), which will be kept in the ED, in which staff must record all emergency messages received and sent and important decisions made. • Establish the Hospital’s Control & Information Team (CIT).

Community • During Office hours a call to Trust Headquarters conveying message (1), (2) or (3) will be put through to the Emergency Planning Office. Contact numbers are 25633700 or 25633785

• After normal business hours the call will go to the Out Of Hours Emergency Social Work Service (Tel: 9446 8833). The duty Co-ordinator on receipt of the call will assess the situation and inform the on-call Emergency Planning Co-ordinator. He/she will take appropriate action to ensure a measured response is put in place, ie request ERT staff to go on alert/respond.

• The on-call Emergency Planning Co-ordinator will also

notify the Director with responsibility for Emergency Planning

notify the appropriate Acute Hospital Emergency Department of the call (for information purpose only)

notify the on-call Public Doctor (Tel: 9040 4045)

commence a written log of all relevant messages received and sent and all important decisions made.

As a working principle the Trust adheres to the following guidance.

“The degree of management will depend upon the nature and scale of the emergency and some (organisations) may be managing the organisational response at strategic level (Senior Managers) where others are managing at operational or tactical level (front line staff)”. (Source: A guide to Emergency Planning Arrangements in Northern Ireland CEPU/OFMDFM).

13 Control & Information Team – Hospital (CIT)

Each Northern Trust Acute Hospital has a CIT. The role of the CIT is to manage and co-ordinate the hospitals response to the incident and deploy staff effectively. Members of the CIT will not be directly involved in treating patients.

Responsibilities include • Will take lead responsibility for the management of the hospital response. • Provide advice, guidance and leadership to hospital staff involved in the emergency response. • Maintain up-to-date information re. Patient condition, patient flow. • Provide appropriate information to PSNI documentation team. • Provide regular contact information to NHSCT Senior Managers via the NHSCT Silver Command structure • Ensure there are sufficient staffing levels and resources available to respond to the emergency. • Provide appropriate information to Head of Corporate Communications/or her deputy for use by the media. • Maintain a log book (written record) of all emergency messages received and sent and important decisions made. • Maintain contact with Regional Health & Social Care Board (if the NHSCT Silver Command is not set up) provided they are operating their emergency procedures and have established their own Command & Control. • Decide at what stage to declare Major Incident “stand down”, and convey this to hospital staff involved in the emergency response. • Manage the return to normal service delivery including: - Restocking of supplies and equipment - Support of staff welfare - Auditing and reporting of incident - Debrief of response and lesson learnt

Note: During the period of a Declared Major Incident Response the hospital may be closed to elective/planned admissions and outpatient clinics may need to be cancelled/rescheduled. CIT must inform the appropriate hospital staff of this decision.

Membership of CIT The Core Team Members are: - Chair/Lead Chief Incident Control Officer (Director/Assistant Director) Lead Consultant for ED/Deputy Nursing Incident Officer Patient Flow Co-ordinator Emergency Planning Lead/Co-ordinator Services/ Information Manager Social Work Representative Representative from PSNI Representative from NIAS Representative from NIFRS (if appropriate)

Location of CIT

Each hospitals CIT will be located as follows:-

Antrim Hospital – Outpatients 3 adjacent to Emergency Dept Causeway Hospital – Seminar Room Emergency Dept Mid-Ulster Hospital – Nursing Admin office (main entrance) Whiteabbey Hospital – Medical Library

Each hospital will also have identified back-up premises available, away from the hospital, in the event of the hospital site not being used as a result of e.g. • Evacuation of hospital • CBRN incident in ED/hospital • Fire at ED

These are Whiteabbey Hospital - Administration Norah Bain Antrim Hospital - IT suite Fern House/or Bush House Causeway Hospital - Mountsandel Centre Mid-Ulster Hospital - Community Social Services Centre, Hospital Road, Magherafelt

The Control & Information Team (CIT) at each hospital site must (a) Ensure equipment including communications (radio/phone/fax/email) is available and working in the designated rooms. (b) Ensure there is an appropriate system for the tracking of patients. (c) Determine how the ED department will be set out to deal with patient flow (d) Establish protocols with relevant staff of the various hospital departments who will have a role in the emergency to ensure a co- ordinated response (e) Ensure there are protocols in place with NIAS in regard to - Loading & unloading of ambulances - Receiving patients at ED - Patient transport - Decant of patients from the hospital (f) Ensure there are protocols in place with PSNI in regard to - Information requirements re patients - Reporting of deaths of patients - Reuniting patients with family members - Handling and storage of patients belongings (g) Ensure there are protocols in place with NIFRS in regard to - Decontamination - Evacuation of building - Fire and rescue (h) Agree suitable location for Family and Friends of patients brought to the hospital and agree with relevant staff (social work, PSNI and Chaplains) roles and responsibilities including management of the facility.

Major Incident in the Community

There may be occasions when a major incident occurs in the community that does not require a hospital response e.g. flooding or evacuation of a residential area.

Under present arrangements the alert may come from a number of sources including PSNI, NIFR, Local Council.

In the event of this type of emergency the above-named agencies have been advised to contact Trust Headquarters during normal/business hours and the Out of Hours Emergency Social Work Service at all other times.

The Trust in conjunction with PSNI, NIAS and local Councils has agreed a protocol viz Emergency Support Centre (ESC) - Protocol. This protocol sets out the roles and responsibilities of the Trust in staffing and managing an ESC. (See page 7 Emergency Response Team (ERT). In such an event members of the Emergency Response Team are the Trust’s first responders. ERT members are contactable at all times during business hours via Trust Headquarters, and at all other times via the Out of Hours Emergency Social Work Service.

Copies of the Protocols are held in the Emergency Planning Office, Trust Headquarters and can be accessed at all times via the Emergency Planning Co-ordinator/Deputy.

16 Northern Health & Social Care Silver Command

The role of the Silver Command during a Declared Major Incident is a strategic one and will support the hospital Control & Information Team (CIT) and Emergency Response Team (ERT).

As a working principle the Trust adheres to the following guidance:

Responsibilities: • Identification of additional resources, including staffing, as requested by CIT/ERT • Maintenance of contact and communications with Regional Health & Social Care Board’s Command and Control Team, if established. • Identify a member to attend a Regional Command or other relevant multi-agencies Command if requested. • Liaise with Head of Corporate Communications in regard to media releases • Liaise with CIT/ERT chair/ lead • Maintain a written log of emergency messages sent or received, and record important decisions made. • Following the Major Incident stand down; assist the CIT/ERT in a resumption of normal services within the hospital/community.

Silver Command will meet at Trust Headquarters, Board Room, The Cottage, Ballymena.

Membership will include:

• Chair/Lead: - Director with Portfolio for Emergency & Business Continuity Planning or his deputy • Executive Director of Nursing/Deputy • Executive Director of Medicine/Deputy • Head of Estate Services/Deputy • Trust’s Emergency Planning Officer • Head of Corporate Communication • Other members of Senior Management Team if appropriate

17 Briefing/Debrief/Care of Staff

Briefings Briefings and Debriefings should be carried out by the lead person of the

• Control & Information Team • Emergency Response Team • NHSCT - Silver Command

Briefing

It is important that a full briefing relating to the major incident and the Trust’s response is given to relevant staff at appropriate times. Equally important when there are shift changes ‘new’ staff arriving must be briefed. Staff completing a shift should have an opportunity to give a full account of tasks completed and outstanding matters yet to be addressed.

Debriefing

Falls into 2 main categories

• Hot Debrief • Formal Debrief

Hot Debrief

• debriefing staff completing their shift and before they go home

purpose to ensure there is an up to date record of tasks completed and tasks yet to be completed

• debrief when Major Incident – Stand down is declared

purpose to ensure all relevant tasks allocated with regard to the major incident response have been completed and that normal service delivery (including restocking of appropriate supplies) can resume

It is also important to facilitate staff to “air their thoughts” re the impact of the emergency on the individual. Note: this is an informal discussion only and should not include discussion regarding appropriate response and its success or otherwise.

Formal Debrief

Should take place within 5 working days of the Major Incident stand down and should be led by the lead Director with responsibility for Emergency Planning or Deputy. Its purpose is to analyse the overall NHSCT response to the major incident taking account of what went well and lessons learnt.

18 A record of the Formal Debrief must be made including any recommendations arising, and forwarded, in writing, to the Director with Portfolio for Emergency & Business Continuity Planning. He/she must ensure that any lessons learnt are;

• conveyed to appropriate staff; and • the major incident plan is reviewed to take cognisance of the points raised.

Care of Staff

It is important following a declared major incident that staff have an opportunity to discuss the impact of the event on self. On occasions this can be achieved through an informal conversation with colleagues, family or friends (bearing in mind issues relating to confidentiality). When a staff member finds they require more than an informal conversation because of the impact on self they can refer to the Occupational Health Department.

The Occupational Health Department will consider the need for Staff referrals following an incident. This will be available through Occupational Health Department and/or Carecall. Staff should be encouraged to contact any of the above directly. Should a line manager have concerns for the welfare of a staff member he/she should discuss this and agree appropriate action.

19 General Roles/Responsibilities

Sections

1. Chief Incident Control Officer

2. NIAS

3. Telephonist

4. Emergency Department Sister

5. Emergency Department Consultant

6. Senior Nursing Incident Officer

7. Patient Flow Co-ordinator

8. Service/Information Manager

9. Radiography Department

10. Portering Services

11. Corporate Communications

12. Hospital Social Work Service

13. Pathology

14. Stand Down

SECTION 1

Role Of Chief Incident Control Officer

Once a major incident has been declared the Director/ Assistant Director of Acute Hospital Services is responsible for: -

• establishing and leading the Major Incident Control Team( CIT) in directing the hospital response • directing the Trust response in the event of Silver Command not being established. • ensuring contact is established with relevant emergency services and other major incident receiving hospitals. • ensuring appropriate arrangements are in place to communicate with the media. • ensuring contact with the Doctor in charge in the Emergency Department and assessing the likely scale and nature of the incident and the state of the initial response. • in liaison with the Patient Flow coordinator ,monitoring the bed capacity and considering and effecting if appropriate patient discharge/transfer. • maintaining communication links with other Trust Acute Hospitals and community services. • ensuring a log is maintained of all critical actions and decisions taken and reasons for same. • issuing a Stand Down, when appropriate for the hospital. • ensuring that de brief meetings are established.

SECTION 2

NORTHERN IRELAND AMBULANCE SERVICE

When The Northern Ireland Ambulance Service responds to a Potential or Declared Major Incident, the Regional Emergency Medical Dispatch Centre will pass all known information using the critical message structure METHANE

M(This is a Potential Major Incident Alert or A Major incident has been declared Exact location, Type of incident, Hazards, Access, Number of casualties, Emergency services present and required)

to the telephonist, Antrim Area Hospital on 02894 424002, Causeway Hospital on 02870 346181 or Mid Ulster Hospital on 02879 631031.

Whiteabbey Hospital is not a receiving Hospital for blue light ambulances

a) Dispatch all necessary Ambulance Service resources to scene. b) Dispatch Ambulance Liaison Officer to Emergency Department Consultant's office. c) Initiate call out of the Public Health Physician on duty if appropriate. d) Establish liaison with Emergency Department and Ambulance Liaison Officer to ensure constant up-date of information and patient movement.

All requests for Ambulance transport from the hospital or on the hospital site should be made with the Ambulance Liaison Officer.

SECTION 3

TELEPHONIST

The Duty Telephonist on receiving a referral from either the PSNI or NIAS of an incident which may be classed as a Major Incident shall immediately transfer the call to

• Emergency Department Consultant or Deputy and await instructions.

Potential Major Incident

It is essential that the telephonist clarifies that the message is either "Potential Major Incident" or "Major Incident Declared" from NIAS and in response should initially activate the hospital's potential procedure (an NIAS/PSNI Major Incident Declared is NOT automatically a hospital Major Incident Declared).

If advised of a Potential Major Incident from a source other than NIAS, the telephonist shall then contact NIAS and pass on/receive any relevant information.

The telephonist, on instruction from the Emergency Department Consultant, shall pass on the following information if available to the CIT

Potential Incident identified by ...... (If identified by NIAS is NIAS on alert or has a NIAS Major Incident been Declared?) • Estimated number and nature of Casualties • Estimated time of arrival of first Casualties • Any special hazards which have been identified (eg chemical contamination)

Major Incident Declared

The duty telephonist will then inform the following personnel that a hospital Major Incident has been declared:- • Ambulance Control • Duty Consultant Surgeon • Duty Consultant Anaesthetist • Surgical Registrar • Anaesthetic Registrar • Patient Flow Co-ordinator

23 • Facilities/Portering Manager • Paediatric Registrar • Haematology and Biochemistry • Radiography Department • Duty Medical Consultant • Pharmacy Department • Outpatients Manager • Corporate Communications • Duty Social Worker or Out of Hours Co-ordinator • Director of Community Health and Social Care • Director of Acute Hospital Services • Director with responsibility for Emergency Planning • Chief Executive

Inform the following that "A Major Incident has been declared at Antrim Area, Causeway, Whiteabbey or Mid Ulster Hospital involving ...... ":

• Local Police Station • NI Fire & Rescue (if Chemical Contamination Incident) • Other Northern Trust Hospital Switchboards

Media/General Public Enquiries

Calls from the media/general public should be directed to the Control and Information Room until the arrival of the Corporate Communications Officer.

SECTION 4

EMERGENCY DEPARTMENT SISTER (not a member of CIT)

Potential Major Incident

• Inform Emergency Department staff and proceed to Emergency Department immediately. • In conjunction with consultant ED consider declaring a major incident on the basis of information received. • Liaise with other CIT Members as soon as possible.

Major Incident Declared

• Inform Emergency Department staff and proceed to Emergency Department immediately. • Ensure that a triage sieve is functioning at each point of patient entry (NB Special guidelines for chemical/radiation incidents). • Ensure that major incident documentation packs are given out with the triage sieve procedure • Arrange for zoning of the Emergency Department to receive patients in categories P1 - P3. • Dispatch nursing staff to appropriate zones and issue action cards to nurse in charge of each zone • Ensure that relatives and other enquirers are directed to the Family and Friends area, away from the Emergency Department. • Ensure that triage sort, primary resuscitation and special arrangements for opiate analgesia are underway in zones one and two. • Liaise with other Major Incident Control Team Members as soon as possible. • Liaise with the Emergency Department Consultant and Social Services to ensure the immediate care of the bereaved. • Monitor staffing/equipment requirements in all three zones throughout the incident. • The design of the Emergency Department is such that the space available allows for storage of sufficient supplies on a day-to-day basis to cater in a Major Incident situation. The Sister in Charge of the Emergency Department must therefore ensure that stock levels including PPE are regularly reviewed and maintained. • Identify site specific location for temporary mortuary.

Stand-down

• Inform Emergency Department staff • Proceed to immediate hot de-brief in Emergency Department.

• Hospital specific plans contain details of specific roles for all Nursing Emergency Department Staff.

SECTION 5

EMERGENCY DEPARTMENT CONSULTANT

Potential Major Incident

• Inform Emergency Department staff and proceed to Emergency Department immediately. • Consider declaring a major incident on the basis of information received. • Liaise with other CIT Members as soon as possible.

Major Incident Declared

• Inform Emergency Department staff and proceed to Emergency Department immediately. • Ensure that appropriate measures are in place to maintain a safe environment for patients, staff and general public (NB special guidelines for chemical/radiation incidents). • Dispatch doctors/nurse practitioners to appropriate treatment zones. • Collate information about number and nature of casualties • Liaise with Duty Surgeon and Anaesthetist about requirement for theatre and ICU, assisting with prioritisation of such cases if necessary. • Liaise with Senior Nurse on Duty about extra nursing teams for extra theatres. • Liaise with Ambulance Liaison Officer about requirements for secondary transfer and capacity for further casualties. • Liaise with other CIT Members as soon as possible. • Liaise with the Emergency Department Sister to ensure the immediate care of the bereaved. • Supervise and monitor staff/equipment and transport requirements in all three zones throughout the incident.

Stand-down

• Inform Emergency Department staff. • Conduct immediate (informal) de-brief in Emergency Department.

• Hospital specific plans contain details of roles for all Medical Emergency Department Staff.

26 SECTION 6

NURSING INCIDENT OFFICER

Following consultation with the other members of the CIT and having agreed to implement the Major Incident Plan the Operational General Manager/Lead Nurse/Duty Sister OOH, will assume the role Nursing Incident Officer (NIO) a) Ensure Hospital Switchboard has been informed that a Major Incident has been declared. b) Inform the Nursing Staff in Emergency Department. c) Assess available nursing resources if required. d) Delegate responsibility to call out off-duty nurses as per up to date schedule of names and telephone numbers. e) Arrange signing-in procedure for staff. f) Deploy nursing staff to Emergency Department, Theatres, Wards, etc. g) In the event of Teams having to attend the scene of a Major Incident emergency clothing and supplies are held within Emergency Department. h) Until the arrival of the Facilities/Portering Manager/Deputy ensure that personnel are posted at key locations. i) Advise Day Procedure Unit and Surgery Units where appropriate to stand- by to receive overflow of less ill in-patients or call in Sister out of hours if between 1700 and 0900 hours. j) Assess with Patient Flow Co-ordinator bed availability throughout hospital for decant purposes. k) Take such other action as set out in instructions held in Nursing Administration. l) In the event of a chemical incident the Nursing Incident Officer will identify a member of staff to be available in Emergency Department to liaise closely with lead Clinician.

27 SECTION 7

PATIENT FLOW CO-ORDINATOR

The Patient Flow Co-ordinator will liaise with the Emergency Department Nurse in Charge regarding the number of anticipated casualties to ascertain the need to free appropriate beds in the Hospital and the potential need to transfer patients to other hospitals. The Patient Flow Co-ordinator will ensure that necessary action is taken by appropriate staff to address this need, using the NHSCT Escalation Policy.

SECTION 8

SERVICE/INFORMATION MANAGER

Potential Major Incident

• Proceed to Emergency Department immediately. • Liaise with other Control and Information Team Members as soon as possible.

Major Incident Declared

Report to the telephonist and take the following action: a) Liaise with the telephonist in calling out or contacting on site the following support staff, where considered appropriate: i Surgical Team Leader ii Receptionist/Admin Support iii Domestic Manager iv HSDU Manager v Patient Administration Officer vi Chaplains vii Catering Services Manager viii Stores Personnel ix Mortician b) If appropriate inform Outpatients Manager and patients to vacate Out- Patients Department. c) If appropriate, relocate Dalriada Urgent Care. d) Set up an INFORMATION ROOM. e) Establish a RECEPTION/HOLDING AREA for relatives of casualties in:-

Antrim Area Hospital Seminar Room 1, Post Grad Causeway Hospital, staff restaurant Mid Ulster Hospital, Sun Lounge Whiteabbey hospital, Out Patients Dept f) If appropriate, inform relevant Managers to vacate appropriate rooms. g) Arrange for lists of casualties and their condition to be prepared in the Information Room for hospital use. h) Provide a 'runner' (eg Porter) who will be responsible for message taking between various Departments and the Information Room.

29 i) Arrange, in liaison with the Emergency Department Consultant/Deputy, to inform all personnel and departments to "Stand Down". j) Ensure staff car park barriers and staff entrance doors are secured. k) Ensure access/egress is available for emergency vehicles attending the hospital site

Information Services

The Service/Information Manager will set up an Information Room as follows:-

Antrim Area Hospital OPD3 Causeway Hospital Seminar Room ED Mid Ulster Hospital Nursing Admin at Reception Whiteabbey Hospital Medical library to which all enquiries about patients will be directed and maintain the lists of casualties and their condition on the boards in the Information Room. The Officer, if advised by the Consultant, Public Health Medicine that a Police Casualty Bureau has become operational, will forward details of casualties to the Police Documentation Team adjacent to the Information Room.

Reception Areas

The Service/Information Manager will advise the Nursing Incident Officer of the location of the Reception/Holding Area designated for relatives of casualties as per point e.

Press Room

The Service /information Manager will, in liaison with the Corporate Communications Officer, establish a further location for use by representatives of the press/media which should be separate from the Reception Area identified for friends and relatives of casualties.

Stand-Down

• Inform support services and nursing staff • Conduct immediate (informal) debrief for support services staff. • Secure all areas as appropriate. • See Hospital specific plans for specific duties

SECTION 9

RADIOGRAPHY DEPARTMENT

Potential Major Incident

Following consultation with the Major Incident Team the Superintendent in charge or Senior Radiographer in charge will initiate the Department Major Incident Protocol.

• See Hospital specific plans for specific role for all Radiography Staff.

SECTION 10

PORTERING SERVICES DEPARTMENT

1. Charge-hand porter on duty to carry out procedures until arrival of Support Services Supervisor and/or Facilities/Information Flow Coordinator.

2. Call in off-duty portering staff as required and issue action cards.

3. Direct and control portering operations.

4. Ensure the availability of medical gases and relevant portering equipment.

5. Ensure directional indicators are in place.

6. Liaise with Facilities/Information Flow Coordinator plus Senior Medical and Nursing Staff regarding accommodation and further portering requirement.

7. Assist with directing relatives, members of the media etc to the designated areas.

SECTION 11

ROLE OF CORPORATE COMMUNICATIONS

Major Incident - Corporate Communications Department out-of-hours procedure

On-call Officer: When advised of incident:

• Confirm CCD is responding and staff are on their way • Get details of incident • Ask for all media enquiries to be noted until arrival Press Officer arrives.

Contact the Head of Communications/Media Manager and pass on the information.

• Go to respective hospital/facility unless otherwise advised by HoC • On arrival report to the Facilities Manager and establish the Press Room and check-in with other CCD staff (if not first to arrive). • If you are the first officer to arrive follow the CCD First Officer’s action.

SECTION 12

THE ROLE OF THE HOSPITAL SOCIAL WORK SERVICE IN A MAJOR INCIDENT

The hospital social work service will provide first response to Major Incidents declared during normal working hours of 9 a.m – 5 p.m Monday to Friday. Outside of these times the first response will be provided by the Trust Emergency Response Team (ERT)

In the event of a major incident the Social Work service will:-

• Meet the immediate psychosocial needs of distressed casualties and relatives. This could include accompanying bereaved relatives to the hospital mortuary.

• Liaise with Medical Records staff, the hospital information centre and the PSNI Casualty Bureau, to assist in the collation of information on casualties and missing persons.

• Keep relatives informed of the progress of casualties by sharing non- clinical information.

• Liaise with Patient Flow Co-ordinator and Community providers to facilitate immediate safe discharge of routine inpatients to increase the number of available beds.

• Arrange for appropriate practical or emotional support for casualties and families.

• Provide written information leaflet to help relatives or casualties recognise and cope with the symptoms of post-traumatic stress.

• Provide any relevant assistance to enable clinical staff to concentrate fully on the clinical task eg, assisting casualties to contact relatives for transport and support, and ensuring domestic arrangements are in place at home.

• Link with community staff to ensure follow up.

• Participate in operational debriefing.

Stand down

Hospital stand-down may be declared by A & E before Social Workers consider their stand-down appropriate. Hospital Senior Social Worker will agree stand-down with Social Work staff.

SECTION 13

MAJOR INCIDENT PATHOLOGY

The laboratory maintains a 24 hour service.

Switchboard should contact the Biomedical Scientists in Haematology/Blood Bank and alert them to the fact that a Major Incident has been declared.

The Biomedical Scientist that is informed by switchboard will immediately follow the relevant departmental Major Incident Plan and alert the other departments within the laboratory.

The laboratory must be updated as to the needs relating to the Major Incident and must also be informed when the incident is declared over.

SECTION 14

STAND DOWN PROCEDURE

Ambulance Control will be responsible for informing the CIT lead that all casualties have been cleared from the scene of the incident. When the Ambulance Service is standing down from a Potential or Declared Major Incident they will use the following terminology:-

Ambulance Service – Stand-down

The fact that the scene of the incident has been cleared will not necessarily mean an immediate stand down. The Control and Information Team lead will liaise with the Emergency Department Consultant/Deputy and in consultation with the other members of the Control and Information Team, will declare a stand down for all hospital departments when appropriate.

APPENDICES

CONTROL AND INFORMATION TEAM MEMBERSHIP

App 1 CONTROL AND INFORMATION TEAM MEMBERSHIP

Core Team Antrim Hospital Mid Ulster Causeway Whiteabbey Members Hospital Hospital Hospital

Acute Hospital Chief Acute Hospital Acute Hospital Acute Hospital Assistant Incident Assistant Director Assistant Assistant Director Director Control Director Officer

Chief ED Consultant on Senior ED ED Consultant on Senior ED Doctor Medical Duty/on call Doctor on Duty Duty/on call on Duty Incident Officer

Critical Care Consultant Consultant Consultant Consultant Anaethetist on Anaethetist on Anaethetist on Anaethetist on Duty/on call Duty/on call Duty/on call Duty/on call

Nursing Office hours – Mrs Office hours Mrs Office hours – Office hours – Incident B Hall,Mrs H K ONeill or Mrs Mrs L Millar or Mrs L Patton Officer / lead McClurg or Mrs P G McKay Mrs S Greenwood Out of hours – nurse McGaw Out of hours – Out of hours – on on call rota Out of hours – on on call rota call rota call rota

Patient Flow Officer on duty Officer on duty Officer on duty Officer on duty Co-ordinator

Services /Information Contact list at Contact list at Contact list at Contact list at Manager switchboard switchboard switchboard switchboard

Corporate Communicat On Call rota On Call rota On Call rota On Call rota ions

Admin To be identified by To be identified To be identified To be identified Support Facilities Manager by Facilities by Facilities by Facilities Manager Manager Manager Office hours Social Work Office hours – Office hours – Office hours – – Hospital Representati Hospital social work Hospital social Hospital social social work ve team work team work team team Out of hours - Out of hours - Out of hours - Out of hours - Emergency Emergency Emergency Emergency Response Team Response Team Response Team Response Team To be requested by To be requested To be requested Representati Chair/Lead by Chair/Lead by Chair/Lead ve for PSNI If appropriate If appropriate If appropriate

To be requested by To be requested To be requested Representati Chair/Lead by Chair/Lead by Chair/Lead ve for NIAS If appropriate If appropriate If appropriate

To be requested by To be requested To be requested Representati Chair/Lead by Chair/Lead by Chair/Lead ve for NIFRS If appropriate If appropriate If appropriate in relation to CBRN incidents only*

Emergency Mrs E Coulter Mrs E Coulter Mrs E Coulter Mrs E Coulter Planning To be contacted by To be contacted To be contacted To be contacted Lead/Co- Chief Incident by Chief by Chief Incident by Chief Incident ordinator for Control Officer if Incident Control Control Officer if Control Officer if Hospital required Officer if required required required

* Chemical, Biological, Radiological or Nuclear incidents

APPENDIX 2

TELEPHONIST

STRICTLY CONFIDENTIAL

TELEPHONISTS MAJOR INCIDENT CHECKLIST

OUT OF HOURS

ACTION TO BE TAKEN TICK TIME REMARKS ALERT On receiving a Potential Major Incident contact and advise the following officers or their deputies of full information available. Emergency Department consultant, Duty Surgeon. Emergency Department Nurse in Charge and Senior Nurse on Duty. If initial alert comes from another source the Telephonist should communicate with Ambulance Control to confirm appropriate action to be taken. 1 CONSULTANT IN EMERGENCY DEPARTMENT

2 SENIOR NURSE ON DUTY – Bleep 5144/5145

3 DUTY SURGEON ON CALL

IF ED CONSULTANT/DEPUTY/SENIOR CLINICIAN ON CALL DECIDES NOT TO IMPLEMENT THE MAJOR INCIDENT PROCEDURE TELEPHONIST SHOULD ADVISE AMBULANCE CONTROL IF ED CONSULTANT/DEPUTY/SENIOR CLINICIAN ON CALL DECIDES TO DECLARE A MAJOR INCIDENT THE FOLLOWING PEOPLE CHOULD BE CONTACTED:- MAJOR INCIDENT DECLARED

1 Ambulance Control

2 Senior Nurse on Duty (if not already aware)

3 CONSULTANT IN EMERGENCY DEPARTMENT (if not already aware)

4 DUTY CONSULTANT ANAESTHETIST/REGISTRAR ON CALL

5 BIOMEDICAL SCIENTIST

6 PATIENT FLOW COORDINATOR

7 ASSISTANT DIRECTOR –

8 RADIOGRAPHER ON CALL

9 SENIOR TRUST OFFICER ON CALL

10 NURSING INCIDENT OFFICER

11 FACILITIES MANAGER

12 SECOND TELEPHONIST

13 DUTY SOCIAL WORKER

14 INFORM OTHER EMERGENCY SERVICE , ie Police – ask PSNI for assistance At Emergency Department Ambulance Fire Service(eg in respect of chemical incident) By dialling 999 and advising “ - - - Hospital implementing Major Incident Plan releating to………”

15 PORTERING/ DOMESTIC SERVICES

16 CORPORATE COMMUNICATIONS

17 INFORM WHITEABBEY/CAUSEWAY AND MID ULSTER SWITCHBOARDS

18 CONTACT FACILITIES MANAGEMENT/NURSING INCIDENT OFFICE FOR ADVICE/INSTRUCTIONS RE FURTHER CALL INSTRUCTIONS FOR CONTACTING NOs 18-30

19 BOILERMAN

20 ADMIN SUPPORT – SURGICAL DIRECTORATE

21 PATIENT ADMINISTRATION OFFICER

22 RECEPTIONISTS

23 PHARMACY

24 HSDU

25 CHIEF EXECUTIVE

26 MEDICAL PHOTOGRAPHER

27 SUPPORT SERVICES MANAGER

28 MORTUARY TECHNICIANS

29 CHAPLAINS

Church of Ireland Methodist Presbyterian Roman Catholic

30 MEDICAL DIRECTOR (FOR INFO ONLY)

31 DIRECTOR OF COMMUNITY HEALTH AND SOCIAL CARE/EXECUTIVE DIRECTOR OF NURSING